Provider Demographics
NPI:1619911799
Name:PATEL, SUMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0517
Mailing Address - Country:US
Mailing Address - Phone:570-281-1315
Mailing Address - Fax:570-281-1256
Practice Address - Street 1:400 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-1638
Practice Address - Country:US
Practice Address - Phone:570-281-1287
Practice Address - Fax:570-281-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036485E2085R0202X, 2085B0100X, 2085N0904X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001391329Medicaid
PAB38500Medicare UPIN
PA001391329Medicaid